Psych Test 1
Longitudinal
observing people on two or more occasions over time Major advantage over cross-sectional studies b/c they can show that the IV precedes/predicts changes in the DV over time
Required Classwork
Get Bachelor's degree first Take GRE test, submit application with essays, letters of rec... Research job ahead of time Psychotherapy Assessment Statistics Research design and methodology Biological bases of behavior Cognitive-affective bases of behavior Social bases of behavior Individual differences Complete research projects Supervised experience working with clients at practicum sites (CAPS) May earn stipend through teaching assistant jobs. Final year is internship under supervision of clinical work before certification
Dorthea Dix (1802-1887)
Sunday school teacher in Boston jail Noticed firsthand that most inmates were there as a result of mental illness or retardation rather than crime Collected city-wise data on treatment of mentally ill Presented data to community leaders for more humane and adequate treatment Efforts resulted in establishment of 30 state institutions throughout the U.S.
Quasi-Experimental
Used when constraints limit the testing of certain hypotheses (research in clinical psych often involves variables that researcher is not entirely able to control, therefore limit the ability to randomly assign to conditions) Less scientifically sound than experimental designs There is probably other differences Ex. fetal alcohol syndrome, child abuse, suicide
Correlational studies
examine the relationship between an independent variable and a dependent variable without manipulating either variable (most common type of study in psychology and medicine!)
PsyD
for people interested in conducting therapy Complete a project or dissertation Takes 4-5 years to complete Accepts higher number of students Cost between 100,000-450,000 mean (270,000)
Case studies
detailed histories of individuals who have some form of psychological disorder
Emil Kraeplin
"Father of Descriptive Psychiatry" Offered 2-category system of mental illness (exogenous/endogenous disorders) This set precedent for creation of diagnostic terms & the development of the Diagnostic and Statistical Manual of Mental Disorders (DSM) DSM published by APA in 1952 Defined and organized mental illnesses DSM-II published in 1968 Similar to DSM DSM-III published in 1980 Specific diagnostic criteria and multiaxial system DSM-III-R, DSM-IV, and DSM-IV-TR Each edition varies from its predecessor DSM-5 published in 2013 More than 300% increase in number of disorders from DSM to DSM-IV Reasons for increase in disorders Scientific discovery Social invention
Prescription privileges
Ability to prescribe psychotropic medications is a core distinction between psychologist and psychiatrists Movement to advocate for prescription privileges for psychologists started in 1980s and has increased in support ever since Creation of APA division 55 States with prescription privileges New Mexico, 2002 Louisiana, 2004 Illinois, 2014 Iowa, 2016 Idaho, 2017 These states are more rural so they don't have psychiatrists- there is a shortage of psychiatrists Why Clinical Psychologists Should Prescribe? Shortage of psychiatrists Clinical psychologists are more expert than primary care physicians Other nonphysician professionals already have prescription privileges Convenience for clients Professional autonomy Professional identification Evolution of the profession Revenue for the profession Why Clinical Psychologists Should Not Prescribe? Training Issues Threats to psychotherapy Identity confusion Potential influence of pharmaceutical industry
Evidence-Based Assessment
Actuarial approach The use of research and theory to inform the selection of assessment targets The methods and measures used in the assessment, and The assessment process itself Using broadband symptom checklists can help clinicians consider alternative diagnoses by decreasing reliance on intuition Clinical "diagnosis as usual" detects on average one less diagnosis per case than using a more structured interview approach 12 Steps in Implementing EBA Identify most common diagnoses in our setting Benchmark the base rates Evaluate risks and moderators Synthesize intake instruments into revised probabilities Interpret cross-informant data patterns Add narrow and incremental assessments to clarify diagnoses Add necessary intensive methods to finalize diagnoses and formulation Finish assessment for treatment planning and goal setting Measure processes (like quizzes, homework) During and after treatment Chart progress and outcome (like midterms and final exams) Monitor maintenance; relapse warnings Seek and use client preferences
Underlying base rates
Amount of people with a certain disease would make you think how likely it is that your client has this disease You should think about the most common disorders first
Role of WW2
Created demand for both assessment and therapy Yerke's Army Alpha- written test & Beta (nonverbal test)? Understanding and treating "shell shock" (PTSD) in returning soldiers
Clinical Scientist Model
In the 1990s, some in the profession began campaigning for a strongly research oriented model of training Richard McFall is one of these individuals behind the clinical scientist movement Those individuals believe that science should be the bedrock of clinical psychology, and that training must stress the scientific aspects more strongly than the Boulder model does Only a minority of graduate programs follow this model
Therapy
Informed consent Couples/families: clarify from outset which individuals are the clients and what the psychologists' relationship is with each person Do not engage in sexual relationships with current clients or individuals they know to have close relationships with clients; do not serve as therapist for former sexual partners Sexual relationships with former clients? Interruption of therapy Termination of therapy
Paprocki (2014)
Is referral based on demographic characteristics discriminatory towards the client? Is not allowing a referral discriminatory towards the practitioner?
History of Abnormality
Possessed by evil spirits Exorcism Trephination- punctured holes in skull
Probability Nomogram
Pretest probability = your base rate Based on an epidemiological study, an 18yo adult has a 6% likelihood of having bipolar disorder Likelihood Ratio for parental history of bipolar disorder DLR= 5.0
Most common job
Private therapy practice is most common (30%)
Arizona House Bill 2565
Signed into law in 2011 "A university or community college shall not withhold any certificate or degree on the basis of a student's religious viewpoint or religious expression" "A university or community college shall not discipline or discriminate against a student in a counseling, social work or psychology program because the student refuses to counsel a client about goals that conflict with the student's sincerely held religious belief or moral conviction"
School Psychologist
Some states require a master's degree; others require PhD for licensure Primary job is to enhance the intellectual, emotional, social, and developmental lives of students Frequently conduct psychological testing (esp. intelligence and achievement tests) to diagnose learning disorders and ADHD Develop programs designed to meet the educational and emotional needs of students (e.g., IEP) Consult and collaborate with teachers/staff/administrators, parents, etc.
Confirmation bias
Spending all of your time chasing down your hypotheses instead of asking questions about other things Ex. You think some has depression so you only ask them questions about that and you ignore and discount any other information that does not support your hypothesis
Telepsychology
Telepsychology: It is the use of internet in psychology. Also known as telehealth, telemental health, cybertherapy. Benefits are "accessibility, affordability, anonymity, acceptability, and adaptability" Provide services to people living in poverty, in rural areas, or in war-torn/violent regions Modes: Videoconferencing E-mail or text Interactive Internet sites Online psychotherapy programs Virtual reality techniques Self-instructional programs Apps and biofeedback sensors on handheld devices Suggestions for online practitioners Obtain informed consent from clients Know and follow laws on telehealth Know and follow recent version of APA ethical code Ensure client confidentiality Appreciate issues of diversity and culture No practice outside scope of expertise Be knowledgeable about emergency resources Choose technologies carefully Dispose of data carefully Stay abreast of changes Effectiveness of Teletherapy Works as well as traditional forms of therapy Weaker client/therapist relationship, but reduction of symptoms somewhat equal Effectiveness depends on: Telepsychology being used Device of delivery Setting of delivery Specific referral knowledgeable source Live human support
Payment
Third party vs. self-payment Traditionally, clients paid directly out of pocket Faster, direct payment Now, health insurance/managed care ("third party payer") may help pay for services Some individuals still pay out of pocket, some pay via insurance, others are a combination Effect of third party payment on psychologists: Negative impact on practice and quality Too much control over clinical decisions Say you much do certain treatment and certain amount of visits will be paid for No confidentiality Lower pay by managed care compared to self-pay by clients Extra time spent on paperwork, phone calls, and other interactions Denial of care to patients Effect on Therapy on clients: Self-pay allows therapist and client to make important decisions Self-pay an unaffordable option for many Managed care makes therapy attainable Effect on Diagnosis: Not paid if disorder does not qualify for a diagnosis Insurance wouldn't cover Psychologists diagnose mild symptoms only when insurance companies pay Only covering EST Session limit Payment by barter? The acceptance of services, goods or other non-monetary payments from clients or patients in return for psychological or counseling services More common with poor clients who seek or need therapy or counseling but do not have the money to pay for it; also more common at times of economic depression Effect of "managed care" -- therapists' financial woes, which in turn are likely to increase their flexibility in terms of payment for services to include bartering and other alternatives to cash payment. Examples of barter Can be the exchange of goods (chicken, cabinetry, painting, etc.) or of services (automobile repair, plumbing, house cleaning, etc.) More common when providers work in rural communities Common examples are: a poor artist barters his/her painting a client cleans the office in exchange for therapy. There are many ways to structure bartering arrangements. One common way is an exchange of the fair market value of the exchanged goods or services. Other bartering of services arrangements are based on an hour-per-hour arrangement, where an hour of client's work is provided in exchange for one therapy hour Boundary crossing and dual relationships?
Disorders may be experienced differently by men and women
Women are more likely to have the disorder and typically have more severe symptoms and a higher level of distress related to it comorbid phobias, generalized anxiety disorder, and PTSD, while men are more likely to have comorbid substance abuse disorder and conduct disorder
Specific symptoms can predict behaviors
hyperarousal symptoms (e.g., agitation) do predict suicidal behavior to a significantly greater extent than other symptoms of the disorder A study found that people with borderline personality disorder (compared to people without it) did in fact respond more negatively to positive social feedback—for example, they were less cooperative
PhD
more common Interested in generating new knowledge through scientific research Takes 5-7 years to complete Normally funded
Treatise on Insanity
new and more practical nosology of maniacal disorders than has yet been offered to the public
Randomized control trials
often take the form of randomized clinical trials (RCTs). In an RCT, researchers test the outcome of a particular, manualized therapy on a particular diagnosis. Each participant is randomly assigned to an experimental condition (treatment group, wait-list control, placebo, etc.) Maximize internal validity through strict inclusion criteria and control over potential confounding variables Criticized for producing results that may not translate to the real world Have a good idea that your treatment will work
originally broken into 2 broad categories
Neurosis Psychosis
Prosenjit Poddar
Graduate student at the University of California, from India Met a woman named Tatiana Tarasoff at dance class in fall 1968 They saw each other about 1x per week On New Year's Eve, she kissed him He interpreted the kiss as a symbol of seriousness to their relationship She replied that she was more interested in other men than him The rejection had a severe emotional impact on Poddar Became emotionally withdrawn Ignored his studies Often spent time alone Wept frequently Spring and summer of 1969 Poddar began seeing a psychologist on campus Tarasoff was on vacation in Brazil for the summer Poddar told his psychologist that he planned to kill Tarasoff when she returned from Brazil Could have contacted the police to come get him while he was there or call after and warn Tatiana The psychologist did believe Poddar; he contacted campus police and requested that he be committed Poddar was briefly detained, but released because he appeared rational and promised to stay away from her Poddar stopped seeing his therapist because of the attempt to hospitalize him The psychologist's superior decided no further steps would be taken to commit Poddar or warn Tarasoff In October... He went to her home to speak with her; she wasn't there and her mother told him to leave He returned later with a pellet gun and butcher knife. When he attempted to talk with her, she began to scream and he proceeded to murder her. Tarasoff vs. Regents of University of California After her death, her parents brought suit against: The psychologist His superior The campus police the University of California (the employer of these entities) Sued due to the failure to warn them, their daughter, or anyone who could have reasonably been expected to notify Tarasoff of her danger AND for their failure to confine Poddar Their case was initially dismissed before bringing appeal to California State Court They ruled in favor of the defendants, saying they were immune from suit for failure to act However, they did rule in Dec 1974 that a psychologist had a "duty to warn" a potential victim This was initially withdrawn due to reaction from psychiatric community but was re-issued 18 mos later with different language Duty to warn When a therapist predicts that his patient is a danger to another person, he has a duty to warn that person of that danger. In addition, if a therapist should have made such a prediction, on the basis of professional standards, "...he bears a duty to exercise reasonable care to protect the foreseeable victim of that danger...." The majority of the Court held: "...our current crowded and computerized society compels the interdependence of its members. In this risk-infested society we can hardly tolerate the further exposure to danger that would result from a concealed knowledge to the therapist that his patient was lethal." (Tarasoff v. Regents of the U. California, 551 P. 2d 334, 1976).
Statistical significance
can indicate quantitatively whether a significant difference exists between two groups
Spread of Asylums
Movements for human treatment in 18th and 19th centuries
Apa's Code of Ethics
APA = American Psychological Association The DSM is also published by the "APA" but that one stands for American Psychiatric Association The ethics code applies to psychologists of all specialties (not solely clinical psychologists) First version published in 1953, with 9 revised editions published since then Most recent edition published in 2002, with amendments made in 2010 & 2016 Amendments emphasize the fact that psychologists cannot use particular ethical standards to justify or defend the violation of human rights Amendments made to say that we cannot be involved with torture and cannot use ethics to defend human rights for things like advanced interrigation and torture Role of Iraq war and abu graib
Ancient China
Balancing yin and yang
Assessment
Base opinions contained in recommendations, reports, and diagnostic/evaluative statements on information and techniques sufficient to substantiate their findings Must administer, adapt, score, interpret, or use techniques in a manner and for purposes that are appropriate in light of research/evidence Must obtain informed consent Provide Test data when requested or when required by law: raw/scaled scores, client/patient responses to test questions/stimuli, and psychologists' notes and recordings concerning client statements and behavior during examination Can refrain from releasing to protect client from harm or misuse/misrepresentation of data or test Develop tests/assessments using appropriate procedures and current scientific knowledge for design, validation, reduction/elimination of bias, and recommendations for use When interpreting results, take into account the purpose of the test and various test factors. Must indicate any significant limitations of their interpretations Do not use outdated assessments or recommendations Select evidence-based scoring and interpretation methods Clearly explain results Maintain security of test materials
William Tuke (1732-1822)
Devoted life to improving conditions in asylums in England Raised funds to open York Retreat Good food, work outs, people liked it Tuke's family members continued to run York Retreat after his death
Abnormality: The 4 D's
Dysfunction Distress Deviance Cultural relativism Unusualness Not wearing shoes- is that a mental illness? no Danger
Fundamental Contribution Error
Effects decision-making Overestimate one factor and minimize the contributing factor Ex. mom is annoying and their problems are because of her and this effects your treatment when you are not thinking about the environment and their situations instead
Dissemination
Efforts to promote therapies that have demonstrated effectiveness in treatment studies to large number of therapists
Human Relations
Do not engage in unfair discrimination (based on age, gender/gender identity, race/ethnicity, culture, national origin, religion, sexual orientation, (dis)ability, socioeconomic status, etc) Do not engage in harassment, sexual or otherwise; do not exploit others Avoiding harm Take reasonable steps to avoid harming others Psychologists do not participate in, facilitate, assist, or otherwise engage in torture, defined as any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person, or in any other cruel, inhuman, or degrading behavior that violates Third party requests: clarify from outset what the role of the psychologist is, who the client is, what are the uses of the services/information obtained, the limits to confidentiality Child technically not the client it is the adult Cooperate with other professionals effectively and appropriately Interruption of services Multiple (or dual) relationships: can be problematic for clinical psychologists to know someone professionally—as, say, a therapy client or student—and also to know that person in another way—as, say, a friend, business partner, or romantic partner A significant portion of complaints to the American Psychological Association Ethics Committee in recent years involve "incidents of blurred boundaries" Conflict of interest: impair objectivity, competence, effectiveness or expose person/organization to harm or exploitation Could be personal, scientific, professional, legal, financial, etc. If the dual role with the client makes it difficult for the psychologist to remain objective, competent, or effective, then it should be avoided. Criteria for impropriety Impairment in the psychologist Exploitation or harm to the client Power differential Need for caution and foresight Boundary crossing vs. violations Must obtain informed consent using language that is reasonably understandable to person Educated decision: ensures the person with whom the psychologist is working the opportunity to become knowledgeable about the activities in which they may participate, and it facilitates an educated decision. Moreover, it affords individuals the opportunity to refuse to consent if they so choose. Consent- from parent Assent- willingness of child to do the therapy Research: inform prospective participants about numerous aspects of the study, including its purpose, procedures, and length of time it may require; any predictable risks or adverse effects; incentives for participation; and the right to decline or withdraw from participation. Assessment: offer information about the nature and purpose of the assessment; any relevant fees; the involvement of other parties, if any; and limits of confidentiality (e.g., duty-to-warn or child abuse situations). Therapy: inform clients/patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers. presents the clinical psychologist the chance to begin to establish a collaborative relationship with the client
Licensed professional counselors
Master's degree completed in 2 years; different from counseling psychology Higher acceptance rates compared to similar professions Involves counseling people with general life issues and/or mild mental illness Little to no emphasis on psychological testing or research
Hindsight bias
Once you know something looking back you think you knew it all along
Medieval views
Witches/witchcraft Supernatural possession (view of laypeople) Physicians began to attribute abnormal behavior to physical causes or trauma
Internal validity
refers to the extent to which the change in the dependent variable is due solely to the change in the independent variable
External validity
refers to the generalizability of the result—to what extent is the same finding valid for different settings and populations
Science-Practitioner (Boulder) Model
1949: Training directors came together and reached consensus that training should emphasize both practice and research Graduate students must display competence in: the application of clinical methods (therapy, assessment) AND the research methods necessary Dominant model Conference in Boulder, Colorado Problem is people are unhappy with emphasis on research
Competence
A competent psychologist is someone who is... "sufficiently capable, skilled, experienced, and expert to adequately complete the professional tasks they undertake" (Nagy, 2012). Boundaries of competence Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their continuing education, training, supervised experience, consultation, study, or professional experience When new scientific or professional knowledge is established, or if starting to provide new service or work with new population, must have or obtain competence (or make appropriate referrals- if none available try to do some research in your spare time to help them) Personal problems: "When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties" (Standard 2.06, p. 1064). "Wounded healer" -- study of over 600 clinical psychologists found that about two-thirds had experienced mental health problems themselves, with the most common being depression, anxiety, and eating disorders. Burnout: Refers to a state of exhaustion that relates to engaging continually in emotionally demanding work that exceeds the normal stresses or psychological "wear and tear" of the job (Pines & Aronson, 1988). Causes, based on different researches: Feeling overcommitted to clients; Over-involvement with clients; Having a low sense of control over the therapy; Earning a relatively low salary; Repeatedly think about frustrating aspects of their work; Having relatively little experience; and High levels of neuroticism and perfectionism. Effects: of burnout: Less effective treatment for clients! Poorer therapy outcomes in clients with depression and anxiety, mostly because of disengagement by the therapists Actions: SELF CARE Varying one's work responsibilities. Keeping one's expectations reasonable. Consulting with other professionals. Maintaining a balanced and healthy personal life. Seeking one's own psychotherapy as necessary Psychologists should also remain alert to signs that they are experiencing impairment, and take appropriate action
Clinical judgment
Analysis, evaluation or prediction of disordered or abnormal behavior, symptoms, or other aspects of psychological functioning, includes assessing the appropriateness of a particular treatment and the degree or likelihood of clinical improvement Hard to determine how accurate it is Psychologists should make conscious effort to understand and take steps to minimize errors in decision making Challenges to making clinical decisions Overconfidence Biases Discrepant sources of information Many argue for a stronger emphasis on "actuarial" approaches when making decisions to reduce impact of biases in clinical judgment Use math to weigh decisions
In North Carolina, the duty to warn foreseeable victims of serious danger from a patient, as held in Tarasoff, is not the law
As a result, a psychologist is not required to warn potential victims of danger by his/her patient. However, there is no law that specifically prohibits a psychologist from doing so. In NC, it is left up to the psychologist to determine whether he/she should warn third persons and, if so, how to do so. The psychologist will need to balance confidentiality requirements with the protection of potential victims of harm.
Advertising and Other Public Statements
Avoid false or deceptive statements Examples of public statements: paid/unpaid advertising, product endorsements, grand applications, licensing applications, brochures, directory listing, resumes/CV, lectures/presentations, published materials, Do not make false statement concerning training, experience, degrees, credentials, affiliations, services, scientific/clinical basis for services, degree of success of services, publications/research findings Do not compensate media for publicity in news item; paid advertisements must be identified or clearly recognizable as such Responsible to oversee announcements, catalogs, brochures, advertisements for workshops, seminars, educational programs When providing public advice/comments, ensure statements are within competence and in accord w/ psychological literature and practice; and otherwise consistent w/ Ethics code
House Bill 5040 (The freedom of conscience act)
Bill passed by Michigan state legislature in June 2012 "A public degree or certificate granting college, university, junior college, or community college of this state shall not discipline or discriminate against a student in a counseling, social work, or psychology program because the student refuses to counsel or serve a client as to goals, outcomes, or behaviors that conflict with a sincerely held religious belief of the student, if the student refers the client to a counselor who will provide the counseling or services. Also states that a student may sue an institution for this
Ancient Egypt, Greece, and Rome
Biological theories Hysteria Hippocrates: 4 basic humors Blood Phlegm Yellow bile Black bile Madness as "affliction from the Gods"
Mary Ellen
Born in 1864 & adopted by Thomas and Mary McCormack in 1866 Neighbors heard Mary (adoptive mother) severely beating young Mary Ellen Late 1973, landlord became concerned and asked a missionary Etta Wheeler to check on Mary Ellen Found Mary Ellen to be pale, thin, barefoot, wearing dirty, tattered, thin clothes, with scars on arms/legs from repeated beatings Even found a leather whip laying on the table in plain sight At the time, there were no laws against child abuse or governmental agencies to protect children Etta approached the ASPCA for help advocating for Mary Ellen in court Child abuse and neglect In April 1874, Mary Ellen's case came before the New York Supreme Court and is widely thought to be the first child abuse case in the United States where a child was successfully removed from her guardians for child abuse From this case, other courts and eventually legislatures created laws that mandated reporting child abuse and neglect to state or provincial Child Protection Currently, most of the professionals involved with parents and their children must meet the duty to report abused or neglected children to Child Protective Services. North Carolina's laws on abuse, neglect, and dependency protect "juveniles," meaning anyone under 18 years old who is not married, emancipated or in the military. A case can be opened with CPS or in juvenile court if a parent, guardian, custodian, or caretaker of a child is allegedly responsible for the abuse, neglect or dependency of that child. A juvenile case will not be opened against a third party, such as a teacher or babysitter, though these people can be charged with a crime for abusing a child. In NC, What is abuse? A child is considered abused if his or her parent, guardian, custodian, or caretaker does any of the following: Causes serious physical injury to the child that does not happen by accident, or allows another to do so. Creates a substantial risk of serious physical injury to the child, other than by accident, or allows another to do so. Uses cruel or grossly inappropriate discipline on the child, or allows another to do so. Commits certain sex crimes against the child, or permits or encourages the child to commit sex crimes or participate in sex crimes. Causes serious emotional damage to the child, or allows another to do so. Commits a crime of human trafficking, involuntary servitude, or sexual servitude against the child, or allows another to do so. Encourages or approves of delinquent behavior that involves immoral acts by the child. In NC, What is neglect? A child is neglected if the child does not receive proper care, supervision, or discipline, from the child's parent, guardian, custodian, or caretaker; or the child has been abandoned. A child is neglected if the child lives in an environment injurious to the child's welfare. A child is also neglected if the child is not provided necessary medical or remedial care or is unlawfully placed for adoption. NC: Universal mandated reporting "Any person or institution who has cause to suspect that any juvenile is abused, neglected, or dependent... or has died as a result of maltreatment" is required to make a report to the county department of social services where the child resides or is found A person who knowingly or wantonly (i) fails to report or (ii) prevents another person from making a report as mandated by the universal reporting statute "is guilty of a Class 1 misdemeanor. "Knowingly" is "when the person knows what he or she is about to do and, with that knowledge, proceeds to act," and "wantonly" is when a person "acts with conscious and intentional disregard of and indifference to the rights and safety of others." Ethical issues related to reporting child abuse/neglect When and how to breach confidentiality; How to sustain the therapeutic relationship in light of making the report How to avoid multiple relationships in cases with court involvement.
Lightner Witmer
Born in Philadelphia in 1867 Earned undergraduate degree in business Received doctorate in psychology under Wilhelm Wundt- founder of experimental psychology in 1892 Studied under James McKeen Cattell Psychology studied only as an academic discipline Founded first psychological clinic at University of Pennsylvania in 1896 First time science of psychology was systematically applied 20 psychological clinics modeled on Witmer's ideology by 1914 Worked primarily with children referred by schools, parents, physicians, or community authorities Emphasized that clinical psychology could be applied to adults as well Founded The Psychological Clinic, a scholarly journal Wrote first article "Clinical Psychology" Introduced term clinical psychology Defined clinical psychology as related to medicine, education, and social work Stated need for trained individuals to practice clinical psychology Was uninfluenced by Freud or psychotherapy Treatments not accompanied by plan to measure effectiveness
Philippe Pinel (1745-1826)
Called liberator of the mentally ill Worked to move mentally ill out of dungeons Convinced contemporaries that mentally ill were not possessed by devils Advocated maintenance of patient case history, ongoing treatment notes, and illness classification Treatise on Insanity- know for test
History of Clinical psychology
Clinical psychology came into being in the early 1900s Before that, mentally ill were viewed as "possessed" and were frequently shunned "hospitals" more closely resembled prisons
Social Workers
Conceptualize problems with the concept of how people interact with society (societal ills rather than person) Go into clients homes etc... Connect with social services Masters degree with strong focus on supervised fieldwork
Privacy and Confidentiality
Confidentiality: information between client and therapist cannot be shared with anyone else Included in both the ethical principles and standards Limits to confidentiality Discuss as part of informed consent process What are the limits? Must obtain permission to record sessions Minimize intrusions on privacy Only discuss confidential information when appropriate and with those clearly concerned w/ such matters When consulting w/ colleagues or for didactic purposes, do not disclose confidential information (unless obtained prior consent from client)
Resolving Ethical Issues
Correct or minimize the misuse or misrepresentation of psychologists' work If ethical responsibilities conflict with law, regulations, organizations affiliated with, etc., psychologist must take reasonable steps to resolve conflicts consistent with Code Informal resolution: attempt to resolve issue by bringing it to the attention of that individual Try first Formal resolution: reporting ethical violations Used if not appropriate for informal resolution (e.g., if it has substantially harmed or is likely to cause substantial harm) Might include: referral to state/national committees on ethics, state licensing board, or appropriate institutional authorities Cooperation w/ ethics committees Don't make improper complaints Can't deny a person (employment, admissions, promotion, etc.) solely due to having made or been subject to ethics complaint
Cost effectiveness
Costs may be determined from multiple perspectives.. From the clinician's perspective: the time taken to deliver the intervention Assessment (longer) vs. talk-therapy patient resistance training needed to develop expertise overhead costs From the health care system's perspective: opportunity costs (what else could have been done if resources were not devoted to the intervention) the actual costs of the intervention training needed to deliver the intervention (direct and indirect costs). From the patient's perspective: Unpleasantness side effects travel costs time and effort Nonmonetary costs for the patient could include medication side effects, loss of other activities or options, or discomfort and work associated with a psychosocial intervention.
Record Keeping and Fees
Create and control records of data related to professional and scientific work to facilitate provision of services later by self or other professionals Allow for replication of research design/analyses Meet institutional requirements Ensure accuracy of billing/payments Ensure compliance w. law Maintain confidentiality in records At beginning, psychologist and recipient reach agreement specifying compensation and billing arrangement Bartering for services? Accuracy in reports to payors and funding sources
Education and Training
Ensure programs designed to provide appropriate knowledge and experiences to meet requirements for licensure and certifications Ensure current and accurate description of program (required courses, community service, training goals/objectives, stipends, requirements that must be met for completion of program) Do not require students/supervisees to disclose personal information Timely and specific process for providing feedback Do not engage in sexual relationships with students or supervisees
SCIENCE
Findings expressed primarily through scientific journals that are peer-reviewed & maintain rigorous standards for honesty and accuracy Reproducible results are demanded; experiments precisely described so they can be duplicated exactly or improved upon Failures are searched for and studied closely, b/c incorrect theories can often make correct predictions by accident As time goes on, more and more is learned about the processes under study Convinces by appeal to the evidence, or by arguments based upon logical and/or mathematical reasoning, by making the best case the data permit. When new evidence contradicts old ideas, they are abandoned Does not advocate or market unproven practices or products
Counseling psychology
Get PhD Work with less "disturbed" patients (not as true anymore) Apply to same internships and get same license as clinical Counseling endorses humanistic whereas clinical endorses behaviorism
True experiment
Hallmark of experimental studies is control (of both independent variable and any potentially problematic third variables) Involves the manipulation of independent variable(s) and random assignment to test conditions Experimental group: It receives the experimental treatment. Control group: It does not receive the experimental treatment. can take a number of forms, including: no treatment at all (and no expectation for treatment), being placed on a wait list for treatment (such that treatment is expected later), receiving a placebo (in which the client receives a form of intervention that lacks the "active ingredient" of the experimental treatment), and receiving treatment-as-usual Good for external validity but not internal validity Normal treatment but not what is being tested Between-group design involves experimental group and control group Within-group design Involves comparisons of participants in a single condition at various points in time Mixed-group design
Mcfall's Manifesto
He argues that the future of clinical psychology hinges on our ability to integrate science and practice His manifesto encompasses all of clinical psychology as a whole (not a particular population, content, or theory) He emphasizes the importance of differentiating between scientific and pseudoscientific clinical psychology Cardinal principle: Scientific clinical psychology is the only legitimate and acceptable form of clinical psychology Distinguishes between the idea that science is a set of answers (incorrect) rather than a set of processes/methods to arrive at answers (correct) Highlights the implication of the Boulder definition of "scientist-practitioner" Wants people to be scientists first and back it up with research Creating the idea that there are 2 legitimate types of clinical psychology (science & practice) He also suggests that psychologists should "blow the whistle" or publicly challenge colleagues who are not using acceptable scientific approaches States that just because there is no perfect system of quality assurance doesn't mean we shouldn't provide it at all
Disorders have largely been defined by men
Heart attacks Disorders have also largely been studied in men If a woman breaks out of female social role she may be regarded as mentally unhealthy because she is not fulfilling her role Emotional disorders like depression and borderline personality are more likely to be diagnosed in women
Ethical Standards
If a psychologist is found guilty of an ethical violation, it is a standard (not a principle) that has been violated. written broadly enough to cover the great range of activities in which psychologists engage, but they are nonetheless more specific than the general principles. Although each general principle could apply to almost any task a psychologist performs, each ethical standard typically applies to a more targeted aspect of professional activity.
"Charles"
Imagine you live in a small, close-knit community, where you operate a private practice You begin to work with a middle-aged male named "Charles" He is seeking therapy for a depressed mood and a desire to reduce his alcohol use During the course of your work with Charles, he repeatedly mentions feeling intense guilt and shame. As a result, he continues to drink heavily and remains depressed Whenever you try to gather more information about where his guilt is coming from, Charles shuts down and says he does not want to talk about "the incident" However, you have no idea what the "incident" is that he refers to Finally one day, Charles tells you that he is tired of living with the burden of the knowledge alone and is ready to share with you about the "incident" About 9 months ago (a few months prior to when he first sought you out for therapy), Charles became intoxicated at a bar and decided to drive home Whilst driving under the influence, Charles struck and killed a neighbors' dog that had gotten out of their yard and was loose in the road He witnessed how devastated the neighbors' children were at the loss of their beloved pet and heard assertions around town about how careless and evil the person was for leaving the scene without helping the dog or alerting the family to the accident You cannot really tell unless you think he is still an imminent threat If he is still routinely drinking and driving you could tell If he drove drunk to the session you could call and tell
Ward v. Polite
In 2009, Julea Ward was a graduate counseling student at Eastern Michigan University (EMU) She requested a client be re-assigned b/c she thought her religious faith "prohibited her from 'affirming' or 'validating' the 'homosexual behavior' of counseling clients" Client was referred as requested However, faculty reviewed her capacity to continue program They saw her behavior as a violation of the ethics code (discrimination based on sexual orientation) She was expelled from the program She sued EMU, claiming this decision violated her first amendment rights to free speech and exercise of religion District court ruled in favor of EMU Appeals court reversed the decision & case resolved w/ $75k settlement paid to ward
Therapy Approaches In Clinical Psychology:
Psychodynamic approach Behavioral approach Humanistic therapy Family therapy Cognitive therapy
Keeton v. Anderson-Wiley
Jennifer Keeton, counseling graduate student at Augusta State University in 2010 In discussions and assignments, she stated that if a client disclosed homosexuality to her, she would tell him that it was morally wrong and attempt to change his behavior; she also said she would refer him to a conversion therapist As a result, faculty was concerned she would have difficulty separating her religious values from her duties They developed a remediation plan to assist her in learning to practice in accordance with the Code of ethics Multicultural workshops, peer-reviewed articles on working with LGB populations, increased exposure and interaction w/ LGB community, and reflection papers on what she had learned She sued the university claiming it violated her First Amendment rights and that they were trying to alter her beliefs by requiring her to complete the remedial plan Court rejected her claims, finding no evidence that applying w/ Ethics Code was designed to make her change her beliefs
PSEUDOSCIENCE
Literature aimed at general public with no review, standards, publication verification, or demand for accuracy and precision Results cannot be reproduced or verified. Any studies are always so vaguely described that one cannot discern what/how things were done Type 1 error- false positive Type 2 error- Failures are ignored, excused, hidden, lied about, discounted, explained away, rationalized, forgotten, avoided at all costs No physical phenomena or processes are ever found or studied; no progress is made; nothing concrete is ever learned Convinces by appeal to faith and belief; has strong quasi-religious element. It tries to convert, not convince. You are to believe in spite of the facts, not because of them. The original idea is never abandoned, whatever the evidence Generally earns some/all of living by selling questionable products (such as books, courses, dietary supplements) and/or pseudoscientific services (such as horoscopes, character readings, spirit messages, predictions)
Psychiatrists
Medical doctors went to medical school Only focus on problems being because of biology rather than emotional etc... Implement medication treatment rather than talk therapy
Assessment
Mental test (James McKeen Cattell, 1890) is used to refer to basic tests of abilities: Reaction time Memory Sensation/perception Types of Assessment Diagnostic Intelligence Personality Objective- multiple choice Projective- looking and describing image of ink
Experimental method
Method involves Observation of events Development of hypothesis to explain observed events Empirical testing of the hypothesis Alteration in hypothesis to match the results Independent variables These are those variables in the study that are manipulated by the experimenter Dependent variables These are those variables that are expected to change as a result of changes in the independent variables Basic vs applied research Hypothesis: testable statement of what we predict will happen in our study Operationalization: the way we measure or manipulate the variables in our study Latent Variable- underlying variable that you can't quantify so you measure it through perationalization Measuring affection through touch How many gestures of doing something nice for your partner you did Sample: group of people taken from the population we want to study Representativeness of the sample is important - want them to be similar to the population of interest in terms of sex, ethnicity, age, etc. If a sample is NOT representative, then we say it has bias Limits your ability to draw conclusions
Research and Publication
Must obtain institutional approval to conduct research prior to conducting research Must gather informed consent from participants for participation and potential recordings of research Offering incentives for participation? Use of deception Debriefing Humane care and use of animals Reporting results: do not fabricate and do not plagarize!
Diagnostic momentum
Once you diagnose them people continue to use it and assume you made it correctly and if it wasn't accurate it will lead to bias in treatment You should still do your own diagnostic assessment so you are not tied to believing what the other clinician said
Practitioner-Scholar (Vail) Model
Only a small portion of clinical psychologists conduct research as their primary activity created in 1973 in response to these concerns Students trained under the Vail model are often offered more coursework related directly to practice and fewer courses on research/statistics More than half of doctoral degrees being awarded are now PsyD degrees, despite the fact that there are fewer PsyD programs than PhD programs Conference in Vail, Colorado
Eli Todd (1762-1832)
Physician in Connecticut Spread Pinel's words and work in the U.S. Raised funds to open The Retreat Emphasized patients' strengths, not weaknesses Similar institutions opened in other U.S. states
Celia Fisher's model for ethical decision making
Prior to any ethical dilemma arising, make a commitment to doing what is ethically appropriate. Become familiar with the American Psychological Association ethical code. Consult any law or professional guidelines relevant to the situation at hand. Try to understand the perspectives of various parties affected by the actions you may take. Consult with colleagues (always protecting confidentiality) for additional input and discussion. Generate and evaluate your alternatives. Select and implement the course of action that seems most ethically appropriate. Monitor and evaluate the effectiveness of your course of action. Modify and continue to evaluate the ethical plan as necessary.
Why do clinical psychologists do research?
Psychological disorders = fundamental reason for research To gain knowledge about psychological disorders To establish a foundation for the field Research to explore issues of diagnosis and categorization Validity or reliability of existing or proposed diagnostic constructs Relationships between disorders Prevalence or course of disorders Treatment outcome -- research to determine how well particular therapies work Explore which therapies treat which disorders successfully Publish treatment outcome studies in professional journals Assessment methods Research to evaluate and improve assessment methods Development, validation, or expanded use of new instruments Establishment of normative data for specific populations on an assessment tool Comparison of multiple assessment tools to one another
First Corollary
Psychological services should not be administered to the public (except under strict experimental control) until they have satisfied these four minimal criteria: The exact nature of the service must be described clearly. The claimed benefits of the service must be stated explicitly. These claimed benefits of the service must be validated (quality) scientifically. Offering invalid or unsupported treatments == failure to exercise appropriate quality control Life coach Eye movement for PTSD proven scientifically but not necessarily true Possible negative side effects that might outweigh any benefits must be ruled out empirically.
Fidelity and responsibility
Psychologists establish relationships of trust with those with whom they work. They are aware of their professional and scientific responsibilities to society and to the specific communities in which they work. Psychologists uphold professional standards of conduct, clarify their professional roles and obligations, accept appropriate responsibility for their behavior, and seek to manage conflicts of interest that could lead to exploitation or harm. Psychologists consult with, refer to, or cooperate with other professionals and institutions to the extent needed to serve the best interests of those with whom they work. They are concerned about the ethical compliance of their colleagues' scientific and professional conduct. Psychologists strive to contribute a portion of their professional time for little or no compensation or personal advantage.
Justice
Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists. Psychologists exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices.
Respect for peoples' rights and dignity
Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination. Psychologists are aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making. Psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status, and consider these factors when working with members of such groups. Psychologists try to eliminate the effect on their work of biases based on those factors, and they do not knowingly participate in or condone activities of others based upon such prejudices.
Integrity
Psychologists seek to promote accuracy, honesty, and truthfulness in the science, teaching, and practice of psychology. In these activities psychologists do not steal, cheat, or engage in fraud, subterfuge, or intentional misrepresentation of fact. Psychologists strive to keep their promises and to avoid unwise or unclear commitments. In situations in which deception may be ethically justifiable to maximize benefits and minimize harm, psychologists have a serious obligation to consider the need for, the possible consequences of, and their responsibility to correct any resulting mistrust or other harmful effects that arise from the use of such techniques.
Apa code: Aspirational and enforceable General Principles: Beneficence and non-maleficence-
Psychologists strive to benefit those with whom they work and take care to do no harm. In their professional actions, psychologists seek to safeguard the welfare and rights of those with whom they interact professionally and other affected persons, and the welfare of animal subjects of research. When conflicts occur among psychologists' obligations or concerns, they attempt to resolve these conflicts in a responsible fashion that avoids or minimizes harm. Because psychologists' scientific and professional judgments and actions may affect the lives of others, they are alert to and guard against personal, financial, social, organizational, or political factors that might lead to misuse of their influence. Psychologists strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work.
Common criticisms of the scientific basis of psychology
Psychology is merely common sense Psychology does not use scientific methods Psychology cannot yield meaningful generalizations because everyone is unique Psychology does not yield repeatable results Psychology cannot make precise predictions Psychology is not useful to society
Sources of public skepticism
Psychology's failure to police itself Problematic public face of psychology Confusion between psychologists and psychotherapists Hindsight bias Many laypersons view most psychological findings as obvious; this relates to the "I knew it all along" effect, or tendency to perceive outcomes as foreseeable after we know them Illusion of understanding Greedy reductionism Oversimplification by selecting the simplest explanation only Constitutive = all "mind stuff" is ultimately "brain stuff" (neuroscience) Eliminative/greedy =the neural level of explanation supersedes all higher levels of explanation; therefore psychology will eventually be superfluous once neuroscience has advanced enough to translate all behaviors/thoughts/emotions Scientific impotence excuse Failure to distinguish basic from applied research
Common activity
Psychotherapy is the most common activity Some time doing administrative work and charting 35% of time doing therapy still double the amount of any other thing Diagnosis/assessment Teaching Supervision Research/writing Consultation Administration
Tradeoff
The more "controlled" and internally valid an efficacy study is, the more dissimilar it can become from therapy in the "real world," thus undermining external validity
Second Corollary
The primary and overriding objective of doctoral training programs in clinical psychology must be to produce the most competent clinical scientists possible The "scientist-practitioner" goal of Boulder model is confusing/misleading Scientific training should not be concerned with preparing students for any particular job placements Some hallmarks of good scientific training are rigor, independence, scholarship, flexibility in critical thinking, and success in problem solving In order for clinical psychology to have integrity, scientific training must be integrated across settings and tasks. His manifesto ends with a call to action, for clinical psychology to formally adopt his manifesto (or something like it) to officially declare a commitment to building a science of clinical psychology. Published in 1991 It has not been implemented as strongly as he would have wanted but they have moved towards more research to back things up
Ethics Code 2.01 Boundaries of Competence
Where scientific or professional knowledge in the discipline of psychology establishes that an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals, except as provided in Standard 2.02, Providing Services in Emergencies 3.01 Unfair Discrimination In their work-related activities, psychologists do not engage in unfair discrimination based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, socioeconomic status, or any basis proscribed by law. Principle D: Justice Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists. Psychologists exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices. How do we interpret "modifiers" in the code? Modifiers are words like reasonably, appropriate, potentially The modifiers used in some of the standards of this Ethics Code ... are included in the standards when they would: (1) allow professional judgment on the part of psychologists, (2) eliminate injustice or inequality that would occur without the modifier [emphasis added], (3) ensure applicability across the broad range of activities conducted by psychologists, or (4) guard against a set of rigid rules that might be quickly outdated. (APA, 2010, p. 2) So, what does an "appropriate referral" mean? Does this create a loophole?
Cross sectional
assess or compare a participant or group of participants at one particular point in time Cohort effects- could be fundamental difference between the groups that is causing the change (best to keep people the same and do longitudinal study)
Clinical psychology
assessment and treatment of mental illnesses and disabilities Rigorous study and applied practice to understand the physcological facets of the human experience including issues such as behavior, emotions, or intellect Research, teaching, services to understand, predict, and alleviate problems
Clinical significance
has to do with qualitative, real-world significance
Efficacy
the success of a particular therapy in a controlled study conducted with participants who were chosen according to particular study criteria
Effectiveness
the success of a therapy in actual clinical settings in which client problems span a range and clients are not chosen as a result of meeting certain diagnostic criteria; how well does the treatment translate from the lab to clinics, hospitals, schools, etc..
Cultural Competence
understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services. Cultural competence is not only a wise clinical strategy; it is an essential component
